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Gender-Specific Outcomes after Percutaneous Left Atrial Appendage Closure - A Nationwide Readmission Database Analysis
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  • Neel Patel,
  • Sagar Ranka,
  • Adrija Hajra,
  • Dhrubajyoti Bandyopadhyay,
  • Birendra Amgai,
  • Sandipan Chakraborty,
  • Mazin Khalid,
  • Amandeep Goyal,
  • Tarun Dalia,
  • Madhu Reddy,
  • Jacob Shani
Neel Patel
University of Kansas Medical Center
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Sagar Ranka
University of Kansas Medical Center
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Adrija Hajra
Jacobi Medical Center
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Dhrubajyoti Bandyopadhyay
Westchester Medical Center Health Network
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Birendra Amgai
Geisinger Community Medical Center
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Sandipan Chakraborty
Miami Valley Hospital
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Mazin Khalid
Maimonides Medical Center
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Amandeep Goyal
University of Kansas Medical Center
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Tarun Dalia
University of Kansas Medical Center
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Madhu Reddy
University of Kansas Medical Center
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Jacob Shani
Maimonides Medical Center
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Abstract

Background: Thromboembolism-associated stroke is the most feared complication of Atrial fibrillation (AF). Percutaneous left atrial appendage closure (pLAAC) is indicated for stroke prevention in patients with AF who can’t tolerate long-term anticoagulation. We aim to study gender differences in peri-procedural and readmissions outcomes in pLAAC patients. Methods: Using the national readmission database from January 2016 to December 2018, AF patients undergoing the pLAAC procedure were identified. We used multivariate logistic regression analyses and time-to-event Cox regression analyses to conduct the study. Propensity matching with the Greedy method was done for the accuracy of results. Result: 28,819 patients were included in our study. Among them 11,946 (41.5%) were women and 16,873 (58.6%) were men. The mean age of overall population was 76.1 ± 8.5 years, with women ~ 1 year older than men. The overall rate of complications was higher in women (8.6% vs 6.6%, P<0.001), primarily driven by bleeding-related complications i.e., Major bleed (OR: 1.32 95% CI: 1.03-1.69, p=0.029), blood transfusion (OR: 1.45, 95% CI: 1.06-1.97, p=0.019) and cardiac tamponade (OR: 1.80, 95% CI: 1.13-2.89, p=0.014). Women had two times higher peri-procedural ischemic stroke. There was no difference in peri-procedural mortality. Women remained at 20% and 13% higher risk for readmission at 30 days and 6 months of discharge. Conclusion: Women had higher peri-procedural complications and were at higher risk of readmissions at 30 days and six months. However, there was no difference in mortality during the index hospitalization. Further studies are necessary to determine causality.

Peer review status:Published

28 Oct 2021Submitted to Journal of Cardiovascular Electrophysiology
15 Nov 2021Submission Checks Completed
15 Nov 2021Assigned to Editor
17 Nov 2021Reviewer(s) Assigned
08 Dec 2021Review(s) Completed, Editorial Evaluation Pending
08 Dec 2021Editorial Decision: Revise Minor
04 Jan 20221st Revision Received
05 Jan 2022Submission Checks Completed
05 Jan 2022Assigned to Editor
05 Jan 2022Reviewer(s) Assigned
05 Jan 2022Review(s) Completed, Editorial Evaluation Pending
05 Jan 2022Editorial Decision: Accept
12 Jan 2022Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15359